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Q&A: Using the HEART Program to Integrate Medical and Mental Health Care for Teen Moms

We’ve explored the risk of postpartum depression among teen mothers and how they can benefit from mental health treatment and social supports. A recent research study goes further, revealing the results of a Denver-based program that integrates mental health screening and treatment into teen moms’ existing medical care.

Employees of the Colorado Adolescent Maternity Program developed the Healthy Expectations Adolescent Response Team (HEART) program after finding that more traditional screen-and-refer models did not effectively engage young moms in mental health treatment. They designed an integrated mental health care program built around regular case management, open-ended treatment, and continuity of care to address common barriers to engagement such as lack of transportation and fear of stigma.

We spoke with Bethany Ashby, a psychologist in the Colorado Adolescent Maternity Program and assistant professor of psychiatry and OB/GYN at the University of Colorado School of Medicine, about the mental health challenges faced by teens moms and how programs like HEART can make a difference.

NCFY: Can you tell us more about the connection between mental health issues and teen pregnancy?

Ashby: One of the things we found is that girls with anxiety and depression are potentially less motivated to prevent pregnancy. With significant mental health issues, things like talking to a partner [about contraception], going to the doctor, or actually getting contraception are hard to negotiate. We also know that with anxiety, post-traumatic stress, trauma, or childhood sexual abuse, girls may engage in unsafe sex practices. Particularly with the patients I work with, their families are also dealing with significant mental health issues. So, our hope with integrated mental health treatment is to help them take a step out of the cycle.

NCFY: In your article, you mention that underserved populations of young women are thinking about challenges related to poverty, employment, or social supports—not their mental health. How do you address this disconnect?

Ashby: We really emphasize that our job is to be supportive in whatever that looks like for the young women. If I have a patient who I think clearly has depression, and she wants to talk about fighting with her boyfriend, we work on improving communication and social support. This helps with depression and with her relationship. We combine a mental health lens with how the teen understands the issues she faces, and blend them. If we just focus on depression, they would not come back to see me. In this way, we try to be as flexible as possible and meet patients where they are with an open-ended, trauma-informed, flexible therapy approach. We have patients say, “I won’t go to therapy, but I will come back and talk with you.”

Ashby: There are other teen pregnancy programs with mental health treatment, but we do it in a unique way. We see patients postpartum, and we continue mental health treatment for years afterward. There is a huge awareness that adolescent moms need additional mental health support and that need does not end at delivery, which makes our model different.

We also work really hard to have the mental health team meet each client at the beginning of care. Mental health care is part of their overall care in our program. It’s not [us saying], “There is something wrong with you so you need to meet with a psychologist.” It’s just like obstetrics, part of our continuity of care. Also, we believe in developing relationships with teen moms. Once we have a relationship, there are a lot of things we can offer and suggest that they were not open to before. We try to have the same social worker or case manager at every medical visit. We build relationships throughout our team and really see the psychosocial supports as the primary care.

NCFY: What’s next for the HEART program?

Ashby: We are just getting ready to submit an article on the rate of second pregnancy for adolescents in our program. For girls in HEART mental health treatment, their repeat pregnancy rate is lower than the entire program general population, even [among] those without mental health problems.